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Cited by 152Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesPharmaceutical studies and practices

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Methylphenidate Dosing: Twice Daily Versus Three Times Daily

Stein, Mark A., Blondis, Thomas A., Schnitzler, Eugene R., O'Brien, Tara, Fishkin, Julie, Blackwell, Brad, Szumowski, Emily, Roizen, Nancy J.·1996·Pediatrics
DOI 10.1542/peds.98.4.748
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Abstract

Objective. To evaluate the short-term efficacy and side effects associated with two methylphenidate hydrochloride (MPH) dosing patterns. Methods. Twenty-five boys with attention deficit hyperactivity disorder (ADHD) participated in a 5-week, triple-blind, placebo-controlled, crossover evaluation of MPH administered twice (b.i.d.) versus thrice (t.i.d.) per day (mean dose 8.8 ± 5 mg, .30 ± .1 mg/kg/dose). Four dosing conditions (placebo, titration [gradual increase to target dose], b.i.d., and t.i.d.) were used. Dependent measures obtained on a weekly basis included: parent and teacher ratings of child behavior, parent-child conflicts, parent report of stimulant side effects, child self-report of mood symptoms, a sleep log, laboratory measures of attention, and actigraphic recording of sleep activity. Results. All dosing conditions resulted in significant effects on ADHD symptoms when compared with baseline. Relative to placebo, t.i.d. dosing was characterized by improvement on the greatest number of behavioral measures, and both b.i.d. and t.i.d. were generally more effective than titration. Direct comparisons of b.i.d. and t.i.d. dosing revealed that t.i.d. was associated with greater improvement on the Conners Parent Rating Scale Impulsivity/Hyperactivity factor, with a similar marginally significant effect for the ADD-H Teacher Rating Scale Hyperactivity factor. The analysis of clinically significant change favored a three-times-a-day dosing schedule over placebo on both parent and teacher ratings of impulsivity/hyperactivity and attention. Compared with placebo, appetite suppression was rated, on average, as more severe in the t.i.d. and titration conditions, but not in the b.i.d condition. However, the number of subjects who exhibited any or severe appetite suppression did not differ significantly between the b.i.d. and t.i.d. schedules. Although there was no difference in sleep duration for children on b.i.d. and t.i.d. schedules, total sleep time appeared to decrease slightly on t.i.d. relative to placebo according to both parent ratings and actigraphic assessment. There were no significant differences between b.i.d. and t.i.d. on any other side effects or sleep variables. Conclusions. For many children with ADHD, t.i.d. dosing may be optimal. There are few differences in acute side effects between b.i.d and t.i.d. MPH dosing. The dosing schedule should be selected according to the severity and time course of ADHD symptoms rather than in anticipation of dosing schedule-related side effects.

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Metadata

Authors
Stein, M. A., Blondis, T. A., Schnitzler, E. R., O'Brien, T., Fishkin, J., Blackwell, B., Szumowski, E., & Roizen, N. J.
Affiliations
University of Chicago (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
1996-10-01
Volume
98
Issue
4
Pages
748-756
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.98.4.748
OpenAlex
W1521375496
Cited by
151
References
0
Citations by year
2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 5 · 2012: 4
FWCI
6.18
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
Keywords
methylphenidate, dosing frequency, twice-daily dosing, three-times-daily dosing, attention deficit hyperactivity disorder, children, stimulant side effects, appetite suppression, sleep duration, sleep quality, impulsivity, hyperactivity, attention, dose titration, parent and teacher ratings, actigraphy, mood symptoms, parent-child conflict, ADHD medication
MeSH terms
Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Capsules, Child, Child Behavior, Cognition, Follow-Up Studies, Humans, Male, Methylphenidate, Sleep, Time Factors

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